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Got my copy of this game this morning, and played through a few times. I thought I'd share my reactions to it in case it's helpful to others.
When the expansion arrived I was a little disappointed, the box was about the size of your average poker deck. This mostly came from Amazon pricing, with Prime pricing I can get any of the other expansions for around $18. I bought Grave Consequences direct from Fantasy Flight and it cost $13, I figured it would be smaller I just didn't realize how much the Amazon discount was.
Size isn't important, its the new ideas the expansion brings that really matters. In my opinion Grave Consequences brings some good ideas. The ideas feel a lot more Chaosium's Call of Cthulhu than Lovecraft's Call of Cthulhu; but they're a fun addition to the game, when they come up.
That has been the big catch for me, these cards only come into play when the player characters die or the Great Old One awakens. Your goal in the game is to not die and keep the old one sleeping, so you can guess that these new cards won't make much difference in most games.
I may as well discuss how the new cards work. There's three new decks you can pull from to spice up the really bad things that happen in the game.
First is the Epic Battles, this comes up when the Old One awakens. In the original game this largely turned the game into all players trying to roll the same combination over and over until they die or the Ole One goes back to sleep. The players are in a bad spot, but the tension was blunted from the repetition. The Epic Battle cards change the conditions for the players every time the clock strikes midnight. I can't say if it makes this situation more difficult, as I had never one once the Old One awakens before, but it does make my final moments before defeat more interesting.
The second deck added is the Phobia Cards, anytime your character should die from losing all their sanity you draw one of these and get to keep playing. Don't assume this is a good thing, yes it's better than being devoured by eldritch horrors, but your character will gain new problems to suffer through. It is always more frightening in a game to almost die, than to actually die. The close brush with death is always so much more tense than discarding your old character and creating a new one, and that's exactly what this mechanic does. It let's a player narrowly escape death by accepting some new penalty and keep playing. This really needs to happen more often in the game, I totally recommend Richard Launius house rule where this should occur when a character's sanity gets low, rather than runs out entirely.
The last deck is the Epitaph Cards. These come out any time a character dies and essentially gives some reaction from the world or the other characters. Perhaps their grief costs them sanity, maybe their fallen comrade's sacrifice encourages them to carry on, maybe the dead rise as shambling beasts and must be put down again. This is a fantastic story element in the game that I wish would come up more often. I tend to get attached to the characters in my games and I love that this gives their deaths more gravitas in the game world.
I can't outright recommend this expansion, I think it brings excellent ideas that enrich the game, but it's impacts come up so infrequently it often seems to be sidelined. If you like the idea of piling on more very thematic troubles when things are already going wrong, you'll like this expansion. If you want something that will supplement each game you play, you'll need to come up with some house rules for this.
That's what I though when I first heard about the "expansion". We will hardly ever use those cards as the main goal in the game is to keep your character alive to prevent the A.O. from awakening. And the effects on the cards are not even innovative. It's more of the same "gain sanity/stamina", "loose sanity/stamina".
I might get this one for collection sake but I'm not a bit excited about it...